Provider Demographics
NPI:1174788525
Name:FEELEY, DAVID P (PT, MPT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:FEELEY
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7567 CENTRAL PARKE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6852
Mailing Address - Country:US
Mailing Address - Phone:513-701-6104
Mailing Address - Fax:
Practice Address - Street 1:600 MEIJER DR
Practice Address - Street 2:STE. 104
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4877
Practice Address - Country:US
Practice Address - Phone:859-538-1165
Practice Address - Fax:859-538-1164
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.012155225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0214940Medicaid
OH0214940Medicaid
P01038936Medicare PIN
00634Medicare PIN